NACT safe, feasible in type 4, large type 3 gastric cancer

  • Terashima M & al.
  • Gastric Cancer
  • 2 Mar 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • In patients with large type 3 or type 4 gastric cancer, adding S-1+cisplatin neoadjuvant chemotherapy (NACT) was associated with reduced operation time, need for reoperation, and postoperative morbidity in patients undergoing D2 gastrectomy and postoperative adjuvant chemotherapy.

Why this matters

  • Gastrectomy with D2 lymph node dissection is a global standard in this setting.

Study design

  • Short-term results of a phase 3 study to compare radical (D2) gastrectomy followed by postoperative adjuvant chemotherapy with (n=151) or without (n=149) S-1+cisplatin NACT in patients with type 4/large type 3 gastric cancer.
  • Median patient age:
    • NACT: 64 (range, 30-75) years.
    • Control patients: 62 (range, 28-75) years.
  • Funding: National Cancer Center Research and Development, Ministry of Health, Labour, and Welfare of Japan.

Key results

  • NACT completion rate, 88%.
  • 92% and 99% of patients in the NACT and control groups, respectively, underwent gastrectomy.
  • Median operation time: 255 (range, 90-477) minutes in control patients vs 240 (range, 50-547) minutes with NACT group (P=.024).
  • 10.9% of control patients and 6.5% of NACT patients experienced grade ≥3 postoperative morbidities (P=.213).
  • 4.1% of control patients and 0.7% of NACT patients required reoperation (P=.0121).

Limitations

  • Japanese patient population; results may not extrapolate to other subgroups.

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